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[WATCH] The Future of Value Based Healthcare – Part 2

By Insights

The Gordon Institute of Business Science (GIBS) recently hosted a number of healthcare experts on the subject of Value Based Healthcare.

The Future of Value-Based Healthcare discussion hosted a panel with the following experts:
– Dr Elton Dorkin, MD of Dr EP Dorkin & Associates
– Victoria Barr, Senior Director at FTI Consulting and co-founder of Alignd
– Jasper Westerink, CEO, Philips Africa
– Dr Shrey Viranna, CEO of Life Healthcare
– Dr Unati Mahlati, Chief Medical Officer, Discovery Health Medical Scheme

This is the second part of the session on Value Based Healthcare:

[WATCH] The Future of Value Based Healthcare – Part 1

By Insights

The Gordon Institute of Business Science (GIBS) recently hosted a number of healthcare experts on the subject of Value Based Healthcare.

The Future of Value-Based Healthcare discussion hosted a panel with the following experts:
– Dr Elton Dorkin, MD of Dr EP Dorkin & Associates
– Victoria Barr, Senior Director at FTI Consulting and co-founder of Alignd
– Jasper Westerink, CEO, Philips Africa
– Dr Shrey Viranna, CEO of Life Healthcare
– Dr Unati Mahlati, Chief Medical Officer, Discovery Health Medical Scheme

This is the first part of the session on Value Based Healthcare:

[LISTEN] The injury prevention myth – predicting, pretending, or preventing sports injuries?

By Insights

Predicting and preventing injuries is seen as the ‘holy grail’ of sports medicine. The literature is brimming with efforts to understand injury prevention, and popular buzzwords such as ‘artificial intelligence’ has seen the emergence of questionable methods to predict sports

In this podcast, Dr Nicol van Dyk speaks to Dr Sean Carmody about current concepts in injury prevention and the validity of the evidence underpinning them. Nicol draws on the experience of his PhD investigating risk factors for hamstring injuries in professional football to forecast the future for preventive efforts in elite sport. Key resources discussed in the podcast have been included below, and if you want to hear more on the topic, Nicol will be presenting at the South African Sports Medicine Association Conference in
October 2019.

Eye-tracking can help diagnose concussion, but it’s under-utilised

By Insights

Concussion can cause serious damage if it’s not properly diagnosed and treated.

Author: Nadja Snegireva, Stellenbosch University

Sports-related concussion has been described by some experts as a “silent epidemic” because it often goes unrecognised.

It’s defined in the 2017 Berlin Consensus Statement on Concussion in Sport as a “traumatic brain injury induced by biomechanical forces”. It typically manifests in the rapid onset of short-term impairment of neurological function. Common symptoms include headaches, nausea, dizziness, confusion or feeling as if you’re in a fog.

A concussion may lead to neuropathological changes – at the level of the nervous system tissue. But it’s not a structural injury. It doesn’t change the brain in a way that can be seen with the naked eye or on traditional neuro-imaging screens. This is part of the reason that it’s not always diagnosed, and why there is still no universal tool to detect concussion. Clinicians have to rely largely on their experience and on the symptoms that injured athletes report.

The problem with self-reporting, though, is that athletes are often not too keen to be removed from the field, so they sometimes understate their symptoms. Younger athletes also struggle to properly verbalise what they feel and don’t necessarily understand the implications of the injury.

Researchers worldwide are working on solutions and methods that will help clinicians to diagnose concussion. One such method could be using eye-tracking. This is a technology for recording eye movements with a small externally mounted camera and then analysing, for example, how fast the eyes move or how accurately they can follow a certain target.

Research has already established that eye-tracking can be used successfully in diagnosing and classifying brain disorders such as schizophrenia or autism.

We believe that eye-tracking also shows promise in concussion assessment. According to research, up to 80% of concussed athletes show some eye movement dysfunction.

But do clinicians know this? We conducted a survey among sports medicine clinicians who deal with concussions to find out. A total of 171 clinicians from 32 countries shared whether they were aware that concussed athletes may have impaired eye movements, and whether they believed that eye-tracking technology has a potential to assist them in assessing concussion.

Clinicians’ feedback

Our survey revealed a few interesting facts.

On whether they knew that concussed athletes may have impaired eye movements, we found that the respondents on average saw eye movement impairments in only 30% of their concussion patients. That’s lower than what we expected.

The reason for this may be that, even though measuring the eye movements without the equipment is possible – for example, asking a patient to look side to side – it is not as accurate. On top of that, 20% of our respondents admitted that they were not checking for any eye movement deficits at all, which indicates they probably were not aware that concussion may lead to abnormal eye-tracking.

And then on the potential of eye-tracking technology to help them assess concussions, most clinicians did see benefits in using eye-tracking. These benefits include objectivity, ease of use (both for the clinician and the patient), replicability of the tests, and the fact that the results can be quantified.

But despite this, many seemed reluctant to implement this technology in their practice. Only 49% of the survey respondents explicitly said that utilising eye-tracking technology for concussion diagnostics was advisable.

There are several understandable reasons for this reluctance: they may not be familiar with this still rather novel technology at all; may lack access to the equipment; or may lack training.

Using technology

The survey happened against the backdrop of several recent developments in eye-tracking for concussion assessment.

First, there have been significant technological advancements in recent years. In 2018 two eye-tracking devices, RightEye and Oculogica’s EyeBOX, designed specifically for concussion assessment were approved by the US Food and Drug Administration. A third device, EYE-SYNC, is currently undergoing a clinical trial in the US.

The prices of the eye-tracking equipment have also dropped tremendously. For instance, EYE-SYNC cost US $6000 in 2018, but is expected to decline to between $1000 and 2000 this year. RightEye is targeting the cost of the tests at $10-$20 per patient.

It’s important to point out that eye-tracking technology isn’t perfect and certainly shouldn’t be the only approach to diagnosing concussion. These developments nevertheless suggest that eye-tracking technology has a valuable role to play in clinical settings.

The way forward

We believe that with ongoing education of clinicians on current developments in the field, and particularly with reference to continuing technological advances, eye-tracking technology could become more common in clinical settings.

Our results suggest that the level of exposure to novel diagnostic tools and clinicians’ acceptance possibly go hand in hand. That’s why we strongly recommend creating training opportunities for concussion evaluation, including the use of potential innovative technology. We also suggest facilitating close interaction between researchers and clinicians regarding the use of latest tools for concussion assessment such as eye-tracking.

All of this could lead to the technology being adopted at a higher rate. This in turn might enable the evaluation of currently somewhat neglected eye movement deficits caused by concussion – and ultimately more accurate evaluation of concussion resolution over days to weeks.

Dr Karen Welman, Stellenbosch University; Professor Wayne Derman, Stellenbosch University & International Olympic Committee (IOC) Research Centre and Professor Jon Patricios, University of the Witwatersrand, co-authored this article.The Conversation

Nadja Snegireva, PhD Researcher in Sport Sciences, Stellenbosch University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Long-haul flights and Super Rugby performance: what the science says

By Insights
Sikhumbuzo Notshe of the Stormers (L) is tackled by Waisake Naholo of the Highlanders (R) during a Super Rugby match between New Zealand’s Highlanders and South Africa’s Stormers.

Author: Michele Lo, Victoria University

Super Rugby is arguably the highest expression of rugby at club level in the world. Its next closest rival in the world of international competitive rugby at club level is the European Rugby Champions Cup (Heineken Champions Cup). Super Rugby involves teams from South Africa, Argentina, New Zealand, Australia and Japan. As the competition is conducted in multiple countries, teams have to travel frequently throughout the six months long season.

Travel is commonly perceived as “the” major factor affecting a team’s performance. Losing away games reduces the chances of finishing high on the ladder or hosting a grand final. Ultimately, it affects the team’s chance of winning. For example, through the 23 years of the competition, only six visiting teams have won the title and only twice has that occurred following international travel to play the final.

We set out to establish whether this perception was scientifically correct. To better understand the complex relationship between regular air travel and athletes’ psycho-physiological response and performance, we investigated the impact of travel on performance during the first 21 years of Super Rugby (1996-2016).

We directly monitored players from four teams following long-haul trans-meridian travel. The findings of our research show that long-haul travel influenced team performance. However, the away-match disadvantage is likely to be the main cause of these negative effects on match outcomes. Fatigue related to long-haul travel is suggested to have a larger impact on players’ individual performance when overseas.

The away-match disadvantageis a combination of factors, such as crowd support and potential officials’ bias that deteriorates the psychological and behavioural states of athletes, along with their performance, when a match is played away.

Although travel and the away-match disadvantage have a similar effect on all teams, when a match is played against a ‘weaker’ opponent, team statistics – like the number of carries, tackles and tries – are only minimally impaired, even following trans-meridian travel. Even if the technical skills and physical performance of players are not particularly affected by travel, playing away from home may affect tactical and strategic aspects of Super Rugby matches, and negatively influence match outcomes.

Jet lag and travel fatigue

There is ample anecdotal support that frequent travel can negatively affect travellers because of travel fatigue and jet lag. Travel fatigue is a state of weariness that accrues after a single trip and accumulates over time. Jet lag occurs when the circadian rhythms, which are the rhythmic pattern of all the physiological functions and systems of the human body, are not synchronised with the external clock.

This typically happens after rapid travel across time-zones. Jet lag is a common complaint reported by travellers crossing more than three time zones during their journey. Symptoms of jet lag include sleep disturbances, fatigue, changes in mood and a deficit in cognitive skills. All of these may detract from an athlete’s peak performance.

So how does this play out for athletes like those competing in Super Rugby?

Varying factors

Performance is complex and may be influenced by many different factors, including travel.

Over the history of Super Rugby it appears quite clear that travel, especially across multiple time zones, had a negative impact on the winning capability of the teams. However, travel fatigue itself had only a limited impact on team performance.

Super Rugby teams reach the match venue at least one day prior to the match and a full night of rest is usually enough to recover from the effects of travel fatigue. Similarly, crossing time zones appears to minimally impair performance. However, the direction of travel largely dictates the magnitude of this impairment: eastward travel is slightly more detrimental than westward travel. As such, for example, a team travelling from South Africa towards Australia or New Zealand will struggle more than a team travelling from South Africa towards Argentina.

This is because eastward travel requires a phase advance of the circadian rhythms while travelling westward requires a phase delay. Circadian rhythms are, on average, slightly longer than 24 hours and the human body shows a natural tendency to drift slightly each day. As such, it is easier to cope with a delay rather than an advance in time.

This means the symptoms of jet lag are more severe after eastward travel, the time required to recover is longer and performance more impaired.

Impaired performance

A number of specific strategies are commonly used by all teams to try and reduce the negative effects of travel. Compression garments can help in reducing travel fatigue and reduce the risk of cramping or even deep vein thrombosis whilst travelling.

Other strategies, mostly based on melatonin supplementation, can help reduce the effect of jet-lag upon arrival. Although these strategies help the team in successfully dealing with long-haul travel, team performance when overseas is still impaired.

Travel is an intrinsic feature of Super Rugby but travel variables are too many to control and therefore there is not a final solution to address all travel related issues. However, our findings suggest that, for the most part, teams appear to be successfully dealing with long-haul travel. Now they should focus on reducing the effects of the away-match disadvantage – for instance by improving players’ behavioural response when competing away from home or implementing different game plans.

Professor Andrew M Stewart (Victoria University), Professor Robert J Aughey (Victoria University) and Associate Professor Nicholas Gill (University of Waikato) co-authored the research on which this article is based.The Conversation

Michele Lo, Researcher at the College of Sport & Exercise Science and Institute for Health and Sport (iHeS), Victoria University

This article is republished from The Conversation under a Creative Commons license. Read the original article.